Proposed cuts in foreign aid could cause malaria resurgence

(Reuters Health) - If U.S. President Donald Trump cuts 44% of the President’s Malaria Initiative (PMI) funding, a significant proportion of the global budget for malaria control, there would be a worldwide resurgence of malaria, British researchers say.

A new, mathematical modeling study estimates that PMI-funded interventions have prevented 185 million malaria cases and saved 940,049 lives since it was first launched under President George W. Bush in 2005.

If PMI funding is maintained, it will prevent 162 million more cases of malaria and save 692,589 lives between 2017 and 2020, the researchers calculate. But if the PMI budget is reduced by 44%, as proposed in President Trump’s “skinny budget” released earlier this year, there will be an additional 67 million cases of malaria and 290,649 deaths from it over the same four years, according to the analysis published online November 21 in PLoS Medicine.

“I think there are always issues with passion fatigue, but malaria is the leading cause of morbidity and mortality around the world,” lead author Dr. Peter Winskill, a research associate at the MRC Center for Outbreak Analysis and Modeling, Imperial College London, told Reuters Health in a phone interview. “PMI is a highly cost-effective way to save lives. There is no better investment in malaria control.”

The parasitic illness, which is transmitted by an infected mosquito, is one of the world’s most common and serious tropical diseases. Children under age 5 are particularly vulnerable to it, and 70% of all malaria deaths occur in this age group. PMI-funded interventions save lives by providing anti-mosquito and anti-parasite measures, including long-lasting insecticide-treated bed nets (LLINS), indoor residual spraying (IRS) with insecticides and diagnosis and treatment with antimalarial drugs, particularly artemisinin-based combination therapies (ACTs).

“If we pull back on the program’s resources there could be and will be an explosive resurgence of malaria in areas where we pushed it back to zero. If we stop short of elimination you get a tremendous rebound,” Dr. Christopher Plowe, director of the Institute for Global Health at the University of Maryland School of Medicine in Baltimore, told Reuters Health by phone.

Plowe, who was not involved in the research, said this happens because once malaria levels fall in a population people lose their immunity to the disease.

Winskill and his colleagues analyzed the transmission of Plasmodium falciparum, the parasite that causes malaria in humans, using a mathematical modeling approach to estimate the impact of PMI funding to date in reducing malaria. They also explored the impact of removing the entire PMI budget, cutting it by 20% and by 44%.

To date, PMI has allocated over $5 billion to 19 countries in sub-Saharan Africa, the hardest hit region in the world, as well as the Mekong region of Asia. Winskill estimated that PMI has had its greatest impact in Nigeria, which has the highest global burden of malaria. The funding prevented an estimated 13.8 million cases of the disease and saved 128,861 lives. In sub-Saharan Africa PMI money led to an 11.6% reduction in malaria rates and an 18.3% reduction in childhood deaths from malaria under age 5.

The study also estimated that continued PMI support would avert an additional $174 million of national health system funding through prevented malaria cases from 2017 to 2020.

One of the limitations of the study, Winskill said, is that he didn’t model the potential mitigating effects of funding that could be put in place by hard-hit countries themselves, if they diverted funding from elsewhere, or money that might come from other donors. The analysis also didn’t capture the possible health system strengthening that PMI may have contributed by improving a country’s health system overall.

“Mathematical modeling always has its limitations because it takes the available information you have and tries to understand it, but it’s very good in detecting potential changes in malaria burden as a result of interventions,” said Dr. Larry Slutsker, leader of the malaria and neglected tropical diseases program at PATH, an international nonprofit global health organization based in Seattle.

“Our progress in malaria control has plateaued in the last several years because funding for it has not increased,” Slutsker, who was not involved in the new study, said in a phone interview. “I’m concerned we are not going to continue to progress and that we are going to lose some ground.”

He noted that HIV/AIDS can make people a bit more vulnerable to malaria, which is another reason PMI funding is so important.